Retrograde Nailing versus Locked Plating of Extra-Articular Distal Femoral Fractures: Comparison of 36 Cases

Objective: The purpose of this study was to retrospectively evaluate the use of locked plating (LP) and retrograde nailing (RN) for treating extra-articular distal femoral fractures. Materials and Methods: From January 2004 to March 2009, 36 patients with extra-articular distal femoral fractures were surgically treated at our Trauma Center. The patients were divided into two groups according to the treatment method, with 19 patients being treated by LP (LP group) and 17 patients via RN (RN group). Results: The demographics of age (p = 0.460) and gender (p = 0.481) in both LP and RN groups were similar. No differences were found with respect to postoperative malreduction, deep infection, hardware failure, operating time, knee pain, HSS score and range of knee movement. The mean intraoperative blood loss was significantly higher in the RN group (298 ± 65.2 ml, range 200–410) than in the LP group (200 ± 48.9 ml, range 130–300) (p 0.01). However, a higher rate of union disturbance was observed in the LP group (36.8%) compared to the RN group (5.9%) (p = 0.044). Conclusions: The overall union disturbance rate in the LP group was higher than in the RN group. However, further analysis revealed that clinical outcome may largely depend on surgical technique rather than on the choice of implant. Therefore, correct rules (the same for every procedure) should be strictly adhered to, especially in the application of LP.